Diagnostic Value of PET/MR with DWI for Burkitt Lymphoma

18F-FDG-PET/MR images, including DWI, of a 46-year-old male admitted to the Emergency Room of our tertiary center, who was suffering from diplopia, left orbital pain, and a headache for two weeks, demonstrated multiple hepatic nodules, a pancreatic mass, and skeletal metastases, in addition to thrombosis of the left cavernous sinus, thickening of the small intestine, and a large hepatic lesion identified at head and neck MR and whole-body CT, respectively. Hepatic and bone marrow biopsies revealed the diagnosis of Burkitt lymphoma. After four cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, methotrexate/ifosfamide, etoposide, and high dose cytarabine (R- CODOX-M/IVAC), a complete metabolic response occurred.

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Case Report—Staged brachytherapy achieving complete metabolic response in unresectable oligometastatic colorectal cancer to the liver

Oxford Medical Case Reports ◽

10.1093/omcr/omab016 ◽

2021 ◽

Vol 2021 (4) ◽

Author(s):

Gokula Kumar Appalanaido ◽

Sheikh Izzat Bin Zainal-Abidin Bahajjaj ◽

Syadwa Abdul Shukor ◽

Muhammad Zabidi Ahmad ◽

Ho Cho Hao Francis

Keyword(s):

Colorectal Cancer ◽

Case Report ◽

Metabolic Response ◽

Tumour Size ◽

Primary Tumour ◽

Local Treatment ◽

High Dose Rate ◽

Tumour Resection ◽

High Dose ◽

Complete Metabolic Response

ABSTRACT Liver is the most common site for metastasis from colorectal cancer (CRC). Non-surgical treatment options for oligometastatic CRC confined to the liver which represents an intermediate state in the metastatic cascade are fast expanding. Currently, several liver-directed local therapeutic options are available, such as hepatic arterial infusion (HAI) therapy, radio-frequency ablation (RFA), transarterial chemoembolization (TACE), stereotactic body radiotherapy and high dose rate brachytherapy (HDRBT). Many factors such as patient’s fitness, liver function (LF), tumour size, location of the tumour in the liver and scheduling of systemic therapy need to be considered when selecting patients for surgery or local liver-directed therapy. This case report illustrates a successful local treatment with staged HDRBT for a large and unresectable, liver only oligometastatic disease from CRC. This patient underwent 4 cycles of chemotherapy (FOLFOX 4) followed by primary tumour resection and first stage of HDRBT to liver for a residual 14 cm tumour after the chemotherapy. After completing a further 4 cycles of chemotherapy with the same regimen, the tumour remained stable at 8 cm. She underwent a second stage of HDRBT to the same lesion and a repeat PET-CT scan done 8 weeks after the second HDRBT showed complete metabolic response. To our knowledge, this is the largest CRC metastatic liver lesion that has been successfully treated with HDRB.

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Neurologic and oncologic features of Erdheim–Chester disease: a 30-patient series

Neuro-Oncology ◽

10.1093/neuonc/noaa008 ◽

2020 ◽

Vol 22 (7) ◽

pp. 979-992 ◽

Cited By ~ 2

Author(s):

Ankush Bhatia ◽

Vaios Hatzoglou ◽

Gary Ulaner ◽

Raajit Rampal ◽

David M Hyman ◽

...

Keyword(s):

Fdg Pet ◽

Metabolic Response ◽

Pet Scan ◽

Complete Metabolic Response ◽

Radiographic Response ◽

Erdheim Chester Disease ◽

Tertiary Center ◽

Fdg Pet Scan ◽

Erdheim Chester ◽

Chester Disease

Abstract Background Erdheim–Chester disease (ECD) is a rare histiocytic neoplasm characterized by recurrent alterations in the MAPK (mitogen-activating protein kinase) pathway. The existing literature about the neuro-oncological spectrum of ECD is limited. Methods We present retrospective clinical, radiographic, pathologic, molecular, and treatment data from 30 patients with ECD neurohistiocytic involvement treated at a tertiary center. Results Median age was 52 years (range, 7–77), and 20 (67%) patients were male. Presenting symptoms included ataxia in 19 patients (63%), dysarthria in 14 (47%), diabetes insipidus in 12 (40%), cognitive impairment in 10 (33%), and bulbar affect in 9 (30%). Neurosurgical biopsy specimens in 8 patients demonstrated varied morphologic findings often uncharacteristic of typical ECD lesions. Molecular analysis revealed mutations in BRAF (18 patients), MAP2K1 (5), RAS isoforms (2), and 2 fusions involving BRAF and ALK. Conventional therapies (corticosteroids, immunosuppressants, interferon-alpha [IFN-α], cytotoxic chemotherapy) led to partial radiographic response in 8/40 patients (20%) by MRI with no complete responses, partial metabolic response in 4/16 (25%), and complete metabolic response in 1/16 (6%) by 18F-fluorodeoxyglucose (FDG)-PET scan. In comparison, targeted (kinase inhibitor) therapies yielded partial radiographic response in 10/27 (37%) and complete radiographic response in 14/27 (52%) by MRI, and partial metabolic response in 6/25 (24%) and complete metabolic response in 17/25 (68%) by FDG-PET scan. Conclusions These data highlight underrecognized symptomatology, heterogeneous neuropathology, and robust responses to targeted therapies across the mutational spectrum in ECD patients with neurological involvement, particularly when conventional therapies have failed.

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High-Dose Samarium-153 Ethylene Diamine Tetramethylene Phosphonate: Low Toxicity of Skeletal Irradiation in Patients With Osteosarcoma and Bone Metastases

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.1.189 ◽

2002 ◽

Vol 20 (1) ◽

pp. 189-196 ◽

Cited By ~ 56

Author(s):

Peter M. Anderson ◽

Gregory A. Wiseman ◽

Angela Dispenzieri ◽

Carola A.S. Arndt ◽

Lynn C. Hartmann ◽

...

Keyword(s):

Bone Metastases ◽

Performance Status ◽

Bone Cancer ◽

Ethylene Diamine ◽

Whole Body ◽

Skeletal Metastases ◽

High Dose ◽

Hematologic Toxicity ◽

Marrow Infusion ◽

Therapeutic Irradiation

PURPOSE: Samarium-153 ethylene diamine tetramethylene phosphonate (153Sm-EDTMP), a bone-seeking radiopharmaceutical, provides therapeutic irradiation to osteoblastic bone metastases. Because the dose-limiting toxicity of 153Sm-EDTMP is thrombocytopenia, a dose-escalation trial using peripheral-blood progenitor cells (PBPCs) or marrow support was conducted to treat metastatic bone cancer. PATIENTS AND METHODS: Patients with locally recurrent or metastatic osteosarcoma or skeletal metastases avid on bone scan were treated with 1, 3, 4.5, 6, 12, 19, or 30 mCi/kg of 153Sm-EDTMP. RESULTS: Thirty patients were treated with 153Sm-EDTMP. Transient symptoms of hypocalcemia were seen at 30 mCi/kg. Estimates of radioisotope bound to bone surfaces and marrow radiation dose were linear with injected amount of 153Sm-EDTMP. Cytopenias also occurred in all subjects and were dose-related. At day +13 after 153Sm-EDTMP, residual whole-body radioactivity was 1% to 65% of whole-body radioactivity considered safe for PBPC infusion, 3.6 mCi. After PBPC or marrow infusion on day +14 after 153Sm-EDTMP, recovery of hematopoiesis was problematic in two patients at the 30 mCi/kg dose infused with less than 2 × 106 CD34+/kg on day +14, but not in other patients. Reduction or elimination of opiates for pain was seen in all patients. Patients had no adverse changes in appetite or performance status. CONCLUSION: 153Sm-EDTMP with PBPC support can provide bone-specific therapeutic irradiation (estimates of 39 to 241 Gy). Hematologic toxicity at 30 mCi 153Sm-EDTMP/kg requires PBPC grafts with more than 2 × 106 CD34+/kg to overcome myeloablative effects of skeletal irradiation. Nonhematologic side effects are minimal.

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1096: Whole Body Optical Imaging of Skeletal Metastases: Pathogenic Relationship with Bone Turnover and Therapeutic Rationale

The Journal of Urology ◽

10.1016/s0022-5347(18)38333-2 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 289-289

Author(s):

Gabri van der Pluijm ◽

Antoinette Wetterwald ◽

George N. Thalmann ◽

Guus Lycklama A. Nijeholt ◽

Rob Pelger ◽

...

Keyword(s):

Bone Turnover ◽

Optical Imaging ◽

Whole Body ◽

Skeletal Metastases

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Scintigraphy with 99m Tc-Phosphonate and 67Gallium in Patients Suspected of Primary Bone Tumors

Nuklearmedizin ◽

10.1055/s-0037-1620567 ◽

1982 ◽

Vol 21 (04) ◽

pp. 136-139 ◽

Cited By ~ 2

Author(s):

C.-J. Edeling

Keyword(s):

Soft Tissue ◽

Bone Scintigraphy ◽

Primary Tumor ◽

Bone Tumors ◽

Whole Body ◽

Skeletal Metastases ◽

Malignant Bone Tumors ◽

67Ga Scintigraphy ◽

Primary Bone Tumors ◽

Primary Bone

Whole-body scintigraphy with both 99mTc-phosphonate and 67Ga was performed on 92 patients suspected of primary bone tumors. In 46 patients with primary malignant bone tumors, scintigraphy with 99mTc-phosphonate disclosed the primary tumor in 44 cases and skeletal metastases in 11, and 67Ga scintigraphy detected the primary tumor in 43 cases, skeletal metastases in 6 cases and soft-tissue metastases in 8 cases. In 25 patients with secondary malignant bone tumors, bone scintigraphy visualized a single lesion in 10 cases and several lesions in 15 cases, and 67Ga scintigraphy detected the primary tumor in 17 cases, skeletal metastases in 17 cases and soft-tissue metastases in 9 cases. In 21 patients with benign bone disease positive uptake of 99mTc-phosphonate was recognized in 19 cases and uptake of 67Ga in 17 cases. It is concluded that bone scintigraphy should be used in patients suspected of primary bone tumors. If malignancy is suspected, 67Ga scintigraphy should be performed in addition.

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MUKnine OPTIMUM protocol: a screening study to identify high-risk patients with multiple myeloma suitable for novel treatment approaches combined with a phase II study evaluating optimised combination of biological therapy in newly diagnosed high-risk multiple myeloma and plasma cell leukaemia

BMJ Open ◽

10.1136/bmjopen-2020-046225 ◽

2021 ◽

Vol 11 (3) ◽

pp. e046225

Author(s):

Sarah Brown ◽

Debbie Sherratt ◽

Samantha Hinsley ◽

Louise Flanagan ◽

Sadie Roberts ◽

...

Keyword(s):

Multiple Myeloma ◽

High Risk ◽

Plasma Cell ◽

Phase Ii ◽

Whole Body ◽

Cell Leukaemia ◽

High Dose ◽

Newly Diagnosed ◽

Genetic Changes ◽

Novel Treatment

IntroductionMultiple myeloma (MM) is a plasma cell tumour with over 5800 new cases each year in the UK. The introduction of biological therapies has improved outcomes for the majority of patients with MM, but in approximately 20% of patients the tumour is characterised by genetic changes which confer a significantly poorer prognosis, generally termed high-risk (HR) MM. It is important to diagnose these genetic changes early and identify more effective first-line treatment options for these patients.Methods and analysisThe Myeloma UK nine OPTIMUM trial (MUKnine) evaluates novel treatment strategies for patients with HRMM. Patients with suspected or newly diagnosed MM, fit for intensive therapy, are offered participation in a tumour genetic screening protocol (MUKnine a), with primary endpoint proportion of patients with molecular screening performed within 8 weeks. Patients identified as molecularly HR are invited into the phase II, single-arm, multicentre trial (MUKnine b) investigating an intensive treatment schedule comprising bortezomib, lenalidomide, daratumumab, low-dose cyclophosphamide and dexamethasone, with single high-dose melphalan and autologous stem cell transplantation (ASCT) followed by combination consolidation and maintenance therapy. MUKnine b primary endpoints are minimal residual disease (MRD) at day 100 post-ASCT and progression-free survival. Secondary endpoints include response, safety and quality of life. The trial uses a Bayesian decision rule to determine if this treatment strategy is sufficiently active for further study. Patients identified as not having HR disease receive standard treatment and are followed up in a cohort study. Exploratory studies include longitudinal whole-body diffusion-weighted MRI for imaging MRD testing.Ethics and disseminationEthics approval London South East Research Ethics Committee (Ref: 17/LO/0022, 17/LO/0023). Results of studies will be submitted for publication in a peer-reviewed journal.Trial registration numberISRCTN16847817, May 2017; Pre-results.

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Association between Oxygen Consumption and Surface Electromyographic Amplitude and Its Variation within Individual Calf Muscles during Walking at Various Speeds

Sensors ◽

10.3390/s21051748 ◽

2021 ◽

Vol 21 (5) ◽

pp. 1748

Author(s):

Kohei Watanabe ◽

Shideh Narouei

Keyword(s):

Oxygen Consumption ◽

Spatial Variation ◽

Metabolic Response ◽

Correlation Coefficients ◽

Surface Emg ◽

Medial Gastrocnemius ◽

Whole Body ◽

Young Males ◽

Emg Amplitude ◽

Calf Muscles

Surface electromyography (EMG) has been used to estimate muscle work and physiological burden of the whole body during human movements. However, there are spatial variations in surface EMG responses within individual muscles. The aim of this study was to investigate the relation between oxygen consumption and surface EMG responses of lower leg muscles during walking at various speeds and to quantify its spatial variation within an individual muscle. Nine young males walked on a treadmill at four speeds: preferred minus 1 km/h, preferred, preferred plus 1 km/h, and preferred plus 2 km/h, and the metabolic response was measured based on the expired gas. High-density surface EMG of the tibialis anterior (TA), medial gastrocnemius (MG), lateral gastrocnemius, and soleus muscles was performed using 64 two-dimensional electrode grids. Correlation coefficients between oxygen consumption and the surface EMG amplitude were calculated across the gait speeds for each channel in the electrode grid and for individual muscles. Mean correlation coefficients across electrodes were 0.69–0.87 for the four individual muscles, and the spatial variation of correlation between the surface EMG amplitude and oxygen consumption within an electrode grid was significantly greater in MG muscle than in TA muscle (Quartile deviations: 0.24 for MG and 0.02 for TA, p < 0.05). These results suggest that the physiological burden of the whole body during gait at various speeds can be estimated from the surface EMG amplitude of calf muscles, but we need to note its spatial distribution within the MG muscle.

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Diagnostic Value of Whole-Body MRI Short Protocols in Bone Lesion Detection in Multiple Myeloma Patients

Diagnostics ◽

10.3390/diagnostics11061053 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1053

Author(s):

Davide Ippolito ◽

Teresa Giandola ◽

Cesare Maino ◽

Davide Gandola ◽

Maria Ragusi ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow Involvement ◽

Bone Lesion ◽

Diagnostic Value ◽

Lesion Detection ◽

Lower Limbs ◽

Whole Body ◽

Bone Lesions ◽

Whole Body Mri ◽

Mri Protocol

The aim of the study is to evaluate the effectiveness of short whole-body magnetic resonance imaging (WBMRI) protocols for the overall assessment of bone marrow involvement in patients with multiple myeloma (MM), in comparison with standard whole-body MRI protocol. Patients with biopsy-proven MM, who underwent a WBMRI with full-body coverage (from vertex to feet) were retrospectively enrolled. WBMRI images were independently evaluated by two expert radiologists, in terms of infiltration patterns (normal, focal, diffuse, and combined), according to location (the whole skeleton was divided into six anatomic districts: skull, spine, sternum and ribs, upper limbs, pelvis and proximal two-thirds of the femur, remaining parts of lower limbs) and lytic lesions number (<5, 5–20, and >20). The majority of patients showed focal and combined infiltration patterns with bone lesions predominantly distributed in the spine and pelvis. As skull and lower limbs are less frequently involved by focal bone lesions, excluding them from the standard MRI protocol allows to obtain a shorter protocol, maintaining a good diagnostic value.

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Complete metabolic response in patients with advanced nonsmall cell lung cancer with prolonged response to immune checkpoint inhibitor therapy

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-002262 ◽

2021 ◽

Vol 9 (3) ◽

pp. e002262

Author(s):

Justin Ferdinandus ◽

Martin Metzenmacher ◽

Lukas Kessler ◽

Lale Umutlu ◽

Clemens Aigner ◽

...

Keyword(s):

Lung Cancer ◽

Cell Lung Cancer ◽

Metabolic Response ◽

Standard Of Care ◽

Nonsmall Cell Lung Cancer ◽

Published Data ◽

Complete Metabolic Response ◽

Positron Emission ◽

Checkpoint Inhibitor Therapy

IntroductionImmunotherapy is the new standard of care in advanced nonsmall cell lung cancer (NSCLC). Recently published data show that treatment discontinuation after 12 months of nivolumab treatment is associated with shorter survival. Therefore, the ideal duration of immunotherapy remains unclear, and finding markers of beneficial outcomes is of great importance. Here, we determine the proportion of complete metabolic responses (CMR) in patients who have not progressed after 24 months of immunotherapy.MethodsThis is a retrospective analysis of 45 patients with positron emission tomography using 2-[18F]fluoro-2-deoxy-D-glucose imaging for assessment of residual metabolic activity after at least 24 months. CMR was defined as uptake in tumor lesions below background levels, using mediastinum as a reference. ResultsOut of 45 patients, 29 patients had a CMR (64%). CMR was observed more frequently in non-first-line patients. Patients with CMR were younger (median 65.7 vs 75.5, p=0.03). Fourteen patients with CMR have discontinued therapy and have not progressed until time of analysis; however, median follow-up was only 5.6 (range 0.8–17.0) months.ConclusionAfter a minimum of 24 months of palliative immunotherapy for NSCLC, CMR occurred in almost two thirds of patients. Potentially, achievement of CMR might identify patients, for whom palliative immunotherapy may be safely discontinued.

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